Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Closed reduction and percutaneous pinning
0%
7/1819
Shoulder hemiarthroplasty
23%
421/1819
Open bone grafting
1%
26/1819
Open reduction and internal fixation (ORIF) with or without bone grafting
65%
1184/1819
Reverse total shoulder arthroplasty (rTSA) with lattisimus dorsi transfer to assist with internal rotation
9%
169/1819
Select Answer to see Preferred Response
A 2-part proximal humerus non-union in a patient with good bone stock without evidence of arthritis or osteonecrosis can be effectively managed with ORIF with locked plating with or without bone grafting. Treatment of a chronic nonunion of the proximal humerus in the elderly should be treated with fixation when possible. Critical attention should be paid to correct all deformities: tuberosity positioning, articular surface realignment, soft tissue balancing, rotator cuff repair (when needed), and treatment of soft tissue contractures. Attempts at arthroplasty are generally recommended only when there is significant osteopenia or avascular necrosis, if the tuberosities have resorbed, if the rotator cuff has a pre-existing tear, or if other findings are present that would limit the success rate of fixation. Quadlbauer et al. evaluated the results of ORIF with locked plating without bone grafting for 9 patients with proximal humerus non-unions with a mean 31-month follow-up. They noted that all 9 patients went on to achieve bony union with improvement in ROM in all planes except fo adduction. They concluded that ORIF with locked plating without bone grafting is a reasonable and safe option for treating proximal humerus nonunion with high union rates and minimal risk of complications Cadet et al. in a JAAOS review article discussed the various management options for proximal humerus non-unions. The authors noted that several recent series did demonstrate union rates >90% for patients treated with ORIF using locking plates and bone graft. They discuss that while reverse shoulder arthroplasty (rTSA) has also shown excellent clinical results, it should be reserved for patients with nonviable humeral heads, severe humeral osteoporosis or deficient rotator cuffs. Incorrect Answers: Answer 1: There is no role for closed reduction in the setting of a non-union Answer 2: While rTSA has shown great results for treatment of proximal humerus non-union, similar results have not recently been shown for shoulder hemiarthroplasty Answer 3: Open bone grafting by itself would not be sufficient for the management of a proximal humerus non-union. The fracture will need stabilizing with locking plate fixation Answer 5: While rTSA is an effective treatment option for proximal humerus non-unions, the addition of a lattisimus dorsi transfer would assist with EXTERNAL rotation, not INTERNAL rotation.
1.0
(4)
Please Login to add comment